Grant W. Carlson, MD, professor of surgery, Emory University School of Medicine, chief, Division of Plastic Surgery, Emory University Hospital, discusses treating younger patients with breast cancer.

Carlson says patients who are younger than 40 years old make up 6-7% of all breast cancer patients in the United States. These patients tend to have more aggressive cancers and require systemic therapy and radiation therapy. Multivariate analysis shows that younger patients tend to do worse, Carlson says, because of the biology of the tumor.

Understanding tumor biology and the necessity for systemic and radiation therapy impacts local choices for a surgeon. Younger patients with breast cancer are unique with regard to psychological and social needs, marital status, desire to have children, and health, Carlson says. These patients are typically image conscious and will seek out breast reconstruction. Carlson says breast conservation is done in younger women but the aggressiveness of their disease often warrants a mastectomy.

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Dr. Carlson on Treating Breast Cancer Patients Under 40

Grant W. Carlson, MD, professor of surgery, Emory University School of Medicine, chief, Division of Plastic Surgery, Emory University Hospital, explains why more women with breast cancer are electing to get contralateral prophylactic mastectomies (CPMs).

Breast cancer is a life-threatening and life-jarring event that most patients do not want to go through a second time, Carlson explains. Even though these women know that prophylactic removal of the other breast is not going to make them live longer, Carlson suggests that CPMs are generally considered because they offer peace of mind.

In some instances, young women choose to have a CPM because they have a strong family history of breast cancer, Carlson notes. There is something about the post-screening process, Carlson believes, that seems to make women feel that a CPM is the best choice. In many situations, Carlson suggests that the patient starts the conversation about CPM.

Grant W. Carlson, MD, professor of surgery, Emory University School of Medicine, chief, Division of Plastic Surgery, Emory University Hospital, explains why more women with breast cancer are electing to get contralateral prophylactic mastectomies (CPMs)

Grant W. Carlson, MD

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Dr. Carlson on Treating Breast Cancer Patients Under 40

Dr. Carlson on Contralateral Prophylactic Mastectomies